Provider Demographics
NPI:1891480737
Name:DAVIS, ALYSSA (LMHC, CRC)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMHC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3955 COCOPLUM CIR APT D
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33063-1844
Mailing Address - Country:US
Mailing Address - Phone:954-330-7663
Mailing Address - Fax:
Practice Address - Street 1:3955 COCOPLUM CIR # 3620
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33063-1844
Practice Address - Country:US
Practice Address - Phone:954-330-7663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-06
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH20704101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional